加味白头翁汤灌肠治疗慢性溃疡性结肠炎临床研究

Study on the therapeutic effect and inflammatory mechanism of enema with modified Baitouweng decoction in the treatment of chronic ulcerative colitis

目的:研究加味白头翁汤灌肠治疗慢性溃疡性结肠炎(UC)的疗效及炎症机制。方法:选取102例慢性UC患者为对象,采用随机数字表法分为对照组50例和观察组52例,对照组给予美沙拉嗪灌肠液灌肠治疗,观察组给予加味白头翁汤灌肠治疗,比较两组临床疗效、中医证候积分、肠黏膜征象积分、炎性因子[白介素-10(IL-10)、白介素-13(IL-13)、白介素-8(IL-8)、肿瘤坏死因子-β(TNF-β)]水平、肠道菌群及不良反应发生率。结果:观察组治疗有效率高于对照组(90.38%与74.00%,P<0.05);治疗后观察组中医证候积分、肠黏膜征象积分、IL-8、TNF-β、大肠埃希菌、肠球菌低于对照组,血清IL-10、IL-13、双歧杆菌、乳酸杆菌水平高于对照组(均P<0.05);两组不良反应发生率比较无统计学差异(P>0.05)。结论:加味白头翁汤灌肠治疗慢性UC疗效显著,可缓解中医证候和肠黏膜征象,改善肠道菌群,其机制与下调IL-8、TNF-β和上调IL-10、IL-13水平有关。

Objective:To study the therapeutic effect and inflammatory mechanism of enema with modified Baitouweng decoction in the treatment of chronic ulcerative colitis(UC).Methods:102 patients with chronic UC were selected and divided into control group(n=50)and observation group(n=52)by random number method.The control group received enema with mesalamine,while the observation group received enema with modified Baitouweng decoction.The two groups were compared in terms of clinical effects,TCM syndrome scores,scores of intestinal mucosal signs,levels of inflammatory factors[interleukin-10(IL-10),interleukin-13(IL-13),interleukin-8(IL-8),tumor necrosis factor-β(TNF-β)],gut microbiota and the incidence of adverse reactions.Results:The effective rate of treatment in the observation group was 90.38%,higher than 74.00%in the control group(P<0.05).After treatment,the TCM syndrome scores,scores of intestinal mucosal sign,IL-8,TNF-β,Escherichia coli and Enterococcus in the observation group were lower than those in the control group.The levels of serum IL-10,IL-13,Bifidobacterium and Lactobacillus were higher than those in the control group(all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Enema with modified Baitouweng decoction is effective in the treatment of chronic UC.It can relieve TCM syndromes and intestinal mucosal signs,and improve gut microbiota.The mechanism is related to down-regulation of IL-8 and TNF-β,and up-regulation of IL-10 and IL-13 levels.